Self-management in Bronchiectasis: barriers and opportunities

Brockwell, Claire (2019) Self-management in Bronchiectasis: barriers and opportunities. Doctoral thesis, University of East Anglia.

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Abstract

A 2018 Cochrane systematic review of self-management for bronchiectasis found scarce, poor quality evidence. National Bronchiectasis Guidelines recommend self-management including ‘basic principles of disease management’, recognition of exacerbation through health changes requiring action - either by self-initiation of treatment (airway clearance or antibiotic therapy) or seeking healthcare assistance.

Existing information sources and a new mixed-method randomised control trial were considered. The intervention aimed to improve self-efficacy in self-managing bronchiectasis. Outcomes were; quantitative patient reported outcomes; qualitative findings thematically analysed from participant focus groups, professional interviews and insights from participants during education. 220 people from 6 East of England hospitals with one or more exacerbations of bronchiectasis within 12 months participated. Randomisation was to treatment as usual alone or in addition to the Bronchiectasis Empowerment Tool (BET). Four brief telephone calls introduced BET which comprised an action plan, four educational sections: sputum, health changes, medications and health interactions (with notepads). Primary outcome at 12 months was the 6-item Self-Efficacy to Manage Chronic Disease Scale (SEMCD). Quantitative/economic data were collected quarterly via mailed self-reported questionnaires for one year. Participant focus groups investigated intervention acceptability and education comments exposed participants’ self-management experiences.

Under-powered, with 12% greater than expected withdrawal the BET intervention did not measurably improve self-efficacy or secondary outcomes. BET did not affect SEMCD (mean difference (0.14 (95% confidence interval (95%CI) -0.37 to 0.64), p=0.59) and showed no significant difference in overall cost to NHS or in QALYs though participants valued the telephone education.

Recruitment success illustrates participant requirement for self-management support, withdrawals raise methodological questions such as literacy burdens (intervention and trial outcome measures). My contribution questions current evaluation methods for quality of life and self-efficacy in bronchiectasis, examining participant motivational needs, their healthcare and social insights, to elucidate the barriers and opportunities for self-efficacy and empowerment in future collaborative self-management.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences
Depositing User: Gillian Aldus
Date Deposited: 05 Aug 2019 13:29
Last Modified: 05 Aug 2019 13:29
URI: https://ueaeprints.uea.ac.uk/id/eprint/71881
DOI:

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